- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $50.12 / $141.25
| Facility | | $14.13 | $50.12 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $15.14 / $21.88
| Professional | | $14.13 | $15.14 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $77.62
| Facility | | $19.50 | $19.50 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $14.45
| Professional | | $9.55 | $9.55 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $100.00 / $138.04
| Professional | | $57.54 | $100.00 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $50.12 / $89.13
| Facility | | $12.88 | $50.12 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $13.18 / $22.39
| Professional | | $10.96 | $13.18 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.44 / $28.84
| Professional | | $19.50 | $23.44 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $33.11 / $38.02
| Professional | | $4.07 | $33.11 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $17.78 / $31.62
| Facility | | $16.60 | $17.78 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $40.74
| Professional | | $5.75 | $5.75 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $27.54 / $10,000.00
| Facility | | $14.13 | $27.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $27.54 / $10,000.00
| Professional | | $15.14 | $27.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $19.50 / $23.44
| Facility | | $8.13 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.75 / $20.42
| Professional | | $8.13 | $11.75 | $20.42 |